Women and children line up outside the community center in the Peruvian village of San Rafael to be seen by doctors and nurses with Louisville-based Centura Global Health Initiatives, which, through a partnership with the Clinica Ana Stahl hospital in Iquitos, brings medical workers from Boulder and across the Front Range to the Amazon jungle five times a year to treat the sick and perform surgeries. (Lisa Marshall )

Opthalmology nurse Bonnie Shippy, of Denver, screens a patient for cataracts in the village of San Rafael in the Peruvian Amazon during a trip by medical workers from Louisville-based Centura Global Health Initiatives. Due to river glare and lack of sunglasses, thousands of adults in the region have been blinded by cataracts.
(Lisa Marshall )

He has been lying here for days, nothing between him and the dusty floorboards but a thin, soiled blanket. His eyes are wild, and beads of sweat dot his forehead. Beside him on the floor, a neighbor clutches his hand and does the only thing people in this remote jungle village can do when someone is critically ill: She prays.

Then, in a surreal scene straight out of a TV drama, two Colorado physicians clad in blue scrubs appear at his doorway, bearing a stethoscope and blood pressure cuff. Within hours, villagers will be hoisting Yumbato, 45, via hammock, to a waiting boat on the shores of the Amazon. By nightfall, he'll be undergoing surgery to repair a gaping hole in his bladder that likely would have killed him by morning.

This is only Day 1.

About this series

Lisa Marshall is a freelance journalist and former Daily Camera editor who spent three weeks in Peru this summer.

Sunday, she writes about Louisville-based Centura Global Health Initiatives' medical work in the Peruvian jungles.

Monday, she writes about her journey to Choquequirao -- aka "Machu Picchu's sacred sister" -- and its connection to a pair of Colorado archeologists, as well as a Boulder company that organizes Inca trail runs in the region.

Yumbato is among the roughly 900 patients who have undergone surgeries and 30,000 who have received care in the past six years via a unique collaboration between Louisville-based Centura Global Health Initiatives (GHI) and Clinica Ana Stahl hospital in Iquitos, Peru.

As the largest city in the world with no roads leading to it, this gritty jungle outpost -- accessible only by boat or small plane -- largely has been cut off from the otherwise booming Peruvian economy. The hundreds of nearby villages that dot the Amazon's banks lack clean water and basic medical care. Malaria, Dengue fever and tuberculosis are facts of life. Most children have parasites. Many adults are blinded by cataracts. And in the wake of the worst flooding in a quarter-century last spring, water-borne illnesses are epidemic.

They're seemingly insurmountable problems for the many well-meaning international volunteer groups that drop in once in a while to hand out vitamins or do minor surgeries.

But GHI is trying a different approach.

Six years after sending its first Boulder medical team to Peru, the organization now sends five groups per year from across Colorado's Front Range. Orthopedic and cataract surgeons, ob/gyns and nurses pay their own way to spend a week not only treating the sick in the villages and performing surgeries in the city, but also training and collaborating with local clinicians.

Via new partnerships with University of Colorado students, and nonprofit groups in Peru, GHI is poised to extend its reach even farther.

Village men carry Cesar Chanchari Yumbato to a waiting boat on the shores of the Amazon. Yumbato suffered a perforated bladder and was gravely ill when doctors from Louisville-based Centura Global Health Initiatives found him. He was taken to the city for surgery.
(Lisa Marshall )

"Our goal is to have as much impact on Iquitos and the surrounding Amazon basin when we are not there as when we are there," says Dr. David Ehrenberger, a six-time volunteer and chief medical officer at Avista Adventist Hospital in Louisville. "That's a big challenge."

A forgotten city

Step out of the airport into Iquitos and the heat and humidity is crushing.

The smog-choked roads buzz with motorized rickshaws hauling wealthy tourists to the port, where speedboats whisk them up the Amazon to $300-per-night jungle lodges. Few spend much time in the city anymore.

Nurses from Louisville-based Centura Global Health Initiatives clean the wounds of 61-year-old Rusbel Fernandez in the village of Pucallpa in the Peruvian Amazon. Fernandez sustained severe burns on his legs when he spilled hot tar on them while working on his canoe.
(Courtesy Charles Boyle)

Home to wealthy rubber barons in the 1880s, and bustling with ex-pat hippies in the 1960s, the once-quaint berg has fallen on harder times, thanks to the discontinuation of several international flights (making it harder for tourists to get here) and the waning global economy. The population has swelled to half a million -- far more than its crumbling infrastructure can sustain -- forcing many to build makeshift houses atop the river itself.

In a floating slum called Belen (Spanish for Bethlehem), smiling children frolic in the murky water just feet from floating outhouses. One teenage girl washes her dishes. A boy casts a fishing line. The stench is overpowering.

On their first day in Peru this past July, the travel weary team of 18 Colorado volunteers floats through the neighborhood and its market with a guide, some snapping pictures, others drifting in silence.

"I've never seen poverty like that before," one young nursing student reflects later, eyes wet. "It makes you feel kind of helpless."

But over the course of the next week, that sense would begin to lift for many on the team.

House calls in San Rafael

Just after 10 a.m. on a Monday, the visitors finally arrive. After an hour ride by rapidos (fast boat) from their hotel in Iquitos, they pull up to the lush river bank and begin unloading plastic tubs filled with antibiotics, flip-flops, sunglasses and other treasures taken for granted back home.

In front of a bright blue community center with a corrugated tin roof, 100 villagers have formed a line. It's already getting hot.

From Colorado to Peru

Global Health Initiatives: Founded in 2004 by Niwot resident Greg Hodgson and administered by Colorado hospital chain Centura Health, Centura Global Health Initiatives (CGHI) sends doctors and nurses from Front Range hospitals to Peru, Rwanda, Nepal and Haiti several times each year to perform surgeries, train health care providers and provide community health services. For more information or to make a donation, visit centuraglobalhealth.org.

CU Peru: CU Peru is a nonprofit group of University of Colorado Anschutz Medical Campus nursing, pharmacy and medical students who train lay health care volunteers in the villages of the Loreto Region of the Peruvian Amazon. For more information or to make a donation, visit cuperu.org.

After a welcome from the mayor, the team gets to work. Outside, nurse Elizabeth Hutson offers children a lesson in hand washing, and distributes toothbrushes. Inside, volunteers Christopher and Marco Coiro, 17 and 11, occupy a group of rambunctious boys with face painting while their mom, Dr. Susanna Coiro, examines a pig-tailed 5-year-old with a suspicious rash on her back -- likely from worms that have entered through her bare feet.

In the corner, ophthalmology nurse Bonnie Shippy screens adults for cataracts in hopes that a future team may operate. (In Peru, roughly 83,000 people have untreated cataracts -- many due to long days worked on the glaring river without eye protection). "Try these," Shippy says, placing a pair of sunglasses on a skeptical elder.

At the door, the line grows.

Soon Susanna Coiro, an internist from Porter Hospital, and Dr. Hila Mitchell, a third-year resident from St. Anthony North Hospital, are pulled aside. Several villagers are too sick to come here. Can they do house calls? They're on the move.

They walk briskly through a tunnel of towering palm trees, past stands of pineapple and rows of grass huts. A shirtless, smiling man walks past carrying a load of charcoal on his back. Two toddlers splash happily in a puddle left behind from yesterday's downpour. A rooster crows.

Compared to Belen, it feels like a tropical paradise. But in one respect, it is at a disadvantage.

When someone gets sick here, the closest hospital is a treacherous boat ride away in a makeshift motorized canoe. Most people can't afford the gas, or the medical bill. So they stay put, brewing teas from local roots and hoping time heals. Sometimes it doesn't. One boy died of pneumonia last month. Before that, a young mother succumbed to a poisonous snake bite.

Offering perspective

At the first hut, the doctors find a 70-year-old woman lying alone on a bare floor. She has not walked for two months, she explains, through an interpreter. She is feverish, her back aches and she shakes when she tries to stand.

Back in Colorado, she would have given blood and urine samples, undergone an ultrasound and been admitted.

Here, the doctors offer their best guess -- severe kidney infection. They give her a 10-day supply of antibiotics and a warm embrace, and move on.

"It really shows that people in the U.S. -- no matter how poor they are or how limited their access is to resources -- still have far beyond what people have in other parts of the world," Mitchell notes.

When she reaches Cesar Yumbato's tiny, dimly-lit hut, Mitchell kneels on the floor, places a stethoscope on his abdomen, and listens. He flinches. Her eyes grow worried.

"He is much sicker than the others," she says.

Fifteen minutes later, a team of nurses is at his side -- one shining a cheap pocket flashlight on his arm while another tries to find a vein. As the IV bag, hanging on a rusted nail above his head, drips fluid into his body, village men arrive at his door with the hammock to haul him to the team's boat.

Back at the community center around 4 p.m., the team is packing up, and Susanna Coiro is seeing her last patient -- a weary-looking young mother with three children jockeying for position on her lap.

After doling out antifungal skin cream, worm medication, multivitamins and antibiotics to the kids, Coiro glances at Mom and asks in Spanish: "Do you need anything for yourself?" The mother pauses -- as if no one has ever asked her this before -- then looks down at her filthy bare feet.

Coiro struggles to keep her composure.

"It's heartbreaking not to be able to do more for them," she says, voice cracking as she reaches for the last pair of flip-flops on the table.

The long view

Throughout the week, the team will see nearly 800 patients and arrange for surgeries for two more.

In the village of Pucallpa, they come upon Rusbel Fernandez, a 61-year-old farmer who, while working on his canoe, spilled a bucket of burning tar on his legs. He'd been sitting in his hut for 16 days, doing his best to keep the flies off as purple scabs engulfed the entirety of his lower legs. As the GHI nurses debrided his infected wounds, he would bear the pain without a wince -- only an occasional "thank you." He would spend 10 days at Clinica Ana Stahl on intravenous antibiotics. But he'd be OK.

In the village of San Juan de Munich, the team would re-unite with 4-year-old Cleider, whose left eye had been swallowed by a painful, blinding mass. Another GHI team had met him in 2011, but needed time to raise money and coordinate with Peruvian doctors for his operation. (He had surgery in September and is said to be doing well.)

But while such dramatic stories may make for good press and serve to attract volunteers and donors, Ehrenberger cautions that doing surgeries and handing out pills is not enough.

"Medical charity work is sexy. But sexy can be toxic," he says, echoing the words of Robert Lupton, author of the new book "Toxic Charity: How Churches and Charities Hurt Those They Help."

"The risk is that we storm in and do some surgeries, treat a few people with pneumonia and then we storm out of town," leaving the patients with no follow-up care, and the region no better off, he said. "It's hard to do it right, and, in some ways, we don't do it right, but we are trying to have a more sustainable impact."

GHI returns to the same 10 villages repeatedly, and has worked with local nonprofit groups, like Rotary, to build clean-water systems in some of them. Doctors and nurses from Clinica Ana Stahl -- a private 30-bed hospital -- work alongside Colorado surgeons during operations, and handle follow-up after they're gone. GHI also has donated equipment and is working to establish an eye clinic there.

"We learn from them and they learn from us," explains Clinica Ana Stahl director Milka Branez Claudet, who visited Colorado in September.

GHI also has led to spin-off organizations, such as CU Peru. The nonprofit group of medical students from the University of Colorado Anschutz Medical Campus now spends each summer in the villages offering free workshops for lay health care workers, called promotores, who otherwise have little or no medical training.

"By returning again and again we would like to someday teach ourselves out of a job," says CU Peru President Shelby Kemper.

Saving lives

But for patients such as Yumbato, the impact already is tangible.

Lying beneath crisp white sheets in his hospital room after his bladder surgery, Yumbato looked weak but pain-free when Coiro and Mitchell dropped in. His incision was healing well, and, within days, he'd be returning home.

The three smiled and posed for a snapshot before parting ways. But none of them would be the same.

"We get as much from them as they get from us," Mitchell says.

Adds Coiro: "We saved one life. To me that alone makes it all worth it."

Lisa Marshall is a freelance journalist and former Daily Camera editor who spent three weeks in Peru this summer, in part traveling with the GHI team.

Volunteer Janie Boyle, far left, leads a group of Colorado doctors and nurses to a village in the Peruvian Amazon to see patients. The team would see roughly 800 patients, saving at least two lives during the week.
(Lisa Marshall )

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